Intensive care unit versus high-dependency care unit admission on mortality in patients with septic shock: a retrospective cohort study using Japanese claims data

Abstract

Background Septic shock is a common and life-threatening condition that requires intensive care. Intensive care units (ICUs) in Japan are classified into ICUs and high-dependency care units (HDUs), depending on presence of full-time certified intensivists and the number of assigned nurses. Compared with other developed countries, there are fewer intensive care beds and certified intensivists in Japan; therefore, non-intensivists often treat patients with septic shock in HDUs. It is unknown where we should treat patients with septic shock because no studies have compared the clinical outcomes between ICU and HDU treatment. This study aimed to elucidate which units should admit patients with septic shock by comparing mortality data and resource use between ICU and HDU admissions. Methods In this retrospective cohort study, we used a nationwide Japanese administrative database to identify adult patients with septic shock who were admitted to ICUs or HDUs between January 2010 and February 2021. The patients were divided into two groups, based on admittance to ICU or HDU on the day of hospitalization. The primary outcome was 30-day all-cause mortality adjusted for covariates using Cox regression analyses; the secondary outcomes were the length of ICU or HDU stay and length of hospital stay. Results Of the 10,818 eligible hospitalizations for septic shock, 6584 were in the ICU group, and 4234 were in the HDU group. Cox regression analyses revealed that patients admitted to the ICUs had lower 30-day mortality (adjusted hazard ratio: 0.89; 95% confidence interval: 0.83–0.96; P = 0.005). Linear regression analyses showed no significant difference in hospital length of stay or ICU or HDU length of stay. Conclusions An association was observed between ICU admission and lower 30-day mortality in patients with septic shock. These findings could provide essential insights for building a more appropriate treatment system.

Impact of the COVID-19 pandemic on the incidence of healthcare facility-onset Clostridioides difficile infection in hospitalized patients with sepsis: Interrupted time series analysis using Japanese Diagnosis Procedure Combination data

“…Therefore, we can identify that a CDI laboratory test had been ordered but cannot know whether the test result was positive. This study was conducted using the same dataset as another clinical research study [ 20 ]. The Kyoto University Graduate School and Faculty of Medicine Ethics Committee approved the study protocol (R3145).…”

Correction: Intensive care unit versus high-dependency care unit admission on mortality in patients with septic shock: a retrospective cohort study using Japanese claims data

“…Following publication of the original article [ 1 ], the authors reported three errors in Tables 5 and 6 .…”

Intensive care unit versus high-dependency care unit admission on mortality in patients with septic shock: let’s think to the survival chain concept for septic shock

“…For septic shock patients, the in-hospital “bundle of care” completion, associated with outcome improvement [ 5 ], from sepsis detection to treatment delivery requires the presence of a sufficient number of qualified caregivers. In Endo et al study [ 1 ], in HDUs, the patient–nurse ratio is two times lower than in ICU and no full-time physician is needed; thus we can suppose that the delays for severity assessment and treatments initiation are probably longer than for patients admitted to ICU, despite Endo et al [ 1 ] study design does not allow this conclusion. Moreover, we cannot exclude the contribution of an influence of patient recruitment volume on the outcome as previously reported for sepsis, subarachnoid hemorrhage and ECMO [ 6 – 8 ].…”

“…We read with great interest the recent article published in the Journal by Endo et al [ 1 ], reporting a positive association between intensive care unit (ICU) compared to high-dependency care units (HDUs) admission and lower 30-day mortality in patients with septic shock.…”

“…The authors must be congratulated for these very interesting findings in line with international sepsis guidelines to develop a more appropriate treatment system [ 2 – 4 ]. Beyond the prompt recognition and the severity assessment of sepsis prior to treatments implementation [ 2 – 4 ], admission to adequate facility to reduce sepsis mortality rate, especially for the sicker ones and the most frail patients, i.e., septic shock, appears to be essential as pointed by Endo et al [ 1 ]. For septic shock patients, the in-hospital “bundle of care” completion, associated with outcome improvement [ 5 ], from sepsis detection to treatment delivery requires the presence of a sufficient number of qualified caregivers.…”